Inspection on 24/01/06 for Ambleside Lodge

This inspection was carried out on 24th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ambleside Lodge 17/07/07

Ambleside Lodge 19/10/06

Ambleside Lodge 20/06/05

Ambleside Lodge 27/01/05

Ambleside Lodge 23/06/04

Ambleside Lodge 29/01/04

Ambleside Lodge 03/10/03

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Ambleside Lodge 25 Ambleside Avenue London SW16 1QE Lead Inspector Sonia McKay Unannounced Inspection 24th January 2006 09.30a Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ambleside Lodge Address 25 Ambleside Avenue London SW16 1QE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8657 6815 Mr Basdeo Kaydoo Mrs Danon Lutchmee Kaydoo Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th January 2005 Brief Description of the Service: Ambleside Lodge is a private staffed home for adults with mental health issues. It is located a short walk from Streatham High Road which has many amenities and good transport links. There is on road parking nearby and off road parking in front of the home. The home provides accommodation and support for five service users. There is a homely living room, dining room, kitchen and laundry and each service user has their own bedroom, there is also a back garden. Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection began at 9.30am and was completed by 12.15pm. The inspection involved a partial tour of the premises, reading care files and home records, talking with one service user and with the home manager. There is currently one vacancy at the home. What the service does well: What has improved since the last inspection? What they could do better: Care plans must be reviewed and re-developed more often to ensure that changing needs and personal goals and aspirations are reflected. Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 6 Service users and staff must have more opportunities to practice fire evacuation drills. Service users must be protected from scalding injuries by fitting appropriate thermostatic controls to hot water outlets in the bathrooms. Staff induction training must be revised to meet sector skills training targets. Staff must have employment contracts. Service users should have more opportunity to develop budgeting, shopping and cooking skills to enable them to better prepare for living alone. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: This group of standards were examined and assessed as being fully met during the 20th June 2005 inspection. Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&9 Written care plans have improved and are now more person-cantered and less focused on problem areas alone. However, to ensure that changing needs and current personal goals are reflected in these plans, they must be revised more often. Service users are supported to take risks as part of developing an independent lifestyle within a framework of risk management developed with the mental health professionals involved with each individual. EVIDENCE: The home manager has devised and introduced a new individual care-planning format. These written plans focus on mental health, physical needs, daily living skills, social networks, cultural needs, employment and therapeutic activity, finance and budgeting and accommodation and future placements. Each service user has signed their respective plans and in some cases have also added their own comments. The care plan identifies goals in each area and how these goals are to be achieved. The care plans examined included goals and decisions made in CPA meetings. Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 10 These plans are a useful tool for staff that are assisting service users to move towards more independent living. To service users have recently moved to their own accommodation. Care plans in place had being evaluated after six months and a separate evaluation form had been completed. However, these reviews had not resulted in a revised care plan even though some goals had been achieved. For service users to receive maximum benefit from dynamic care planning processes, new plans should be developed regularly and new objectives/goals set (either at review or as/if needs change significantly). This will ensure that service users have opportunity to further develop their skills and increase their independence and will give staff a clear picture of their current support needs. (See requirement 1) A new risk assessment format has also been introduced, as required in the previous inspection report. These risk assessments are adequately detailed and reflect risks, strategies and contingency plans identified in CPA meetings. Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 & 17 Service users have opportunity to develop and maintain appropriate personal, family and sexual relationships. Service users are offered a varied range of healthy meals. EVIDENCE: During the previous inspection it was noted that service users were not clear about aspects of the homes visitors policy. For example, service users thought that relatives could spend time in their bedrooms but not friends. To address this the home manager has developed a written policy on visitors that has been introduced and discussed with service users during house meetings. Service users are permitted to have social visits in the privacy of their own bedrooms within reasonable parameters of safety and good behaviour. A record of menus examined indicated that a varied range of evening meals had been prepared and served in the communal ground floor dining room. Culturally appropriate meals are available. Breakfasts and lunches are prepared individually during the week as people are often out. Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 12 There was only one service user at home during the inspection; others were out attending daytime activities. The service user said that the meals were good. To ensure that service users have meals of their choice, a blank menu is distributed each week for service users to fill in with meals of their choosing. Service users are encouraged to assist with meal preparation. To ensure that service users are sufficiently skilled to budget, shop and prepare meals independently, a programme of skills teaching and reducing support should be developed for service users preparing to move to independent accommodation. (See recommendation 1) Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 20 EVIDENCE: The home manager liaises with the local CMHT (Community Mental Health Teams). C.P.Ns (Community Psychiatric Nurses) visit service users living at the home on a regular basis. The manager has also introduced a system of recording for monitoring the mental health of each service user on a daily basis. Physical health needs are well documented and are detailed in individual care plans. Each service user is registered with a local GP. The results of health appointments are recorded in care notes, although service users are encouraged to be responsible for their own physical health where possible, and generally attend appointments without staff support. Medication is held in a lockable, wall-mounted steel cabinet in the staff office. Patient information leaflets about all of the medicines in use in the home are kept to provide staff with information about possible side effects. Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 14 The medication policy includes all recommended topics (including leave medication, refusals and PRN or ‘as required’ medication). Pharmacy generated Medication Administration Records (M.A.R charts) are well maintained with no gaps in recording. A photograph of each service user is available and is attached to the relevant chart. There is a sample signature list for each member of staff involved in medication administration. A small supply of home remedies is available (over-the-counter analgesics). Staff have been trained in the safe administration of medication. Justified medication stock checks are completed each week. Although stock numbers are recorded during these checks there is no record of the outcomes. This is recommended. (See recommendation 2) Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Service users are protected from abuse, neglect and self-harm. EVIDENCE: The home has an adult protection policy with a flow chart to enable staff to know what to do quickly if needed. The policy included information on the need to contact the local authority and the CSCI in cases of suspected abuse. The manager has knowledge of the Protection of Vulnerable Adults list (POVA) of people who should not work with vulnerable adults. The home manager said that the home does not use physical restraint. Whistle blowing training is provided as part of staff induction training. Staff have now attended abuse awareness training, as required in the previous inspection report. The home manager has recently requested a copy of the revised adult protection procedures recently published by Lambeth social services. Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 & 30 There is significant disruption due to current building work. However, the home is generally clean and well maintained and there is ongoing refurbishment. EVIDENCE: The small detached house blends into the local community setting. It is located close to public transport routes, shops and leisure facilities. The communal areas of the home (lounge, dining room and hallways) have recently been redecorated and new double glazed windows have been fitted. The home is well furnished and is clean and free from offensive odours. The registered providers have recently removed a garage, utility area and food storage room on the ground floor of the home. At the time of this inspection, building work was underway to add an additional suite of rooms. There are also plans to increase the size of the communal lounge by extending it into the garden area. The registered providers are seeking planning permission and a variation to the homes registration with the CSCI to increase the number of service users Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 17 who can be accommodated. This proposal will be examined when the building work is completed. Whilst this building work is completed laundry facilities have been moved to a bathroom area and extra refrigerators have been moved to the dining area. The rear garden is also inaccessible. This is not ideal, but as it is a temporary measure it is acceptable, providing that disruption to existing service users is minimised. (See requirement 2) Service users each have a single furnished bedroom. A service user said that he found his bedroom comfortable and adequately heated. There are three toilets and two bathrooms, both with shower fittings. All doors are fitted with an appropriate privacy lock with an over-ride facility for use in an emergency. Environmental health inspectors had visited the home to inspect the kitchen in March 2005. Their report recommends a hazard analysis and written procedures. This is now in place. Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Progress has been made with staff training and development, although reliance on a student workforce has led to a high turnover of staff that affects consistency and continuity of care for service users. Staffing levels are adequate to meet the needs of the service users and are reviewed and risk assessed as required. EVIDENCE: The home manager and registered provider work in the home as core staff. Both are qualified and experienced in providing services for adults with mental health issues. Many of the staff are newly appointed and there has been a high level of staff turnover. All of the staff are students and this has resulted in a large staff team, working fewer hours. The majority of staff are completing nursing training (in areas other than mental health). This has had implications in regard to the cost of training, as all staff must undertake mandatory training, training to meet the specific needs of service users (mental illness) and NVQ training. Student staff often resign when they complete their college or university education. High staff turnover does not provide service users with good consistency and continuity of care. The appointment of permanent full-time staff is recommended. (See recommendation 3). Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 19 Daytime staffing levels consist of two members of staff, including the home manager. Two staff are on duty at night, one awake and one providing sleepover cover. A sleepover room with adequate storage facility is available. A senior member of staff assists with staff ‘in-house’ training in mental health and provides management cover whilst the registered providers are on leave. The home is making progress with NVQ training (9 out of 10 staff have completed/are completing an NVQ qualification at level 2, 3 or 4), and specific mental health training. A team training and development plan is in place for 2005-2006. Recruitment records examined indicated that recruitment procedures had been followed. Application forms, references, Criminal Records Bureau (CRB) checks, photographs, completed health questionnaires, copies of training certificates and copies of passports are in place. Copies of the GSCC Code of conduct are available in the office. Staff induction training records are in place but are not in accordance with Skills for Care training targets. (See requirement 3) Supervision records examined show that staff receive formal supervision with the required frequency, inclusive of annual appraisal. Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 The home is well run with both registered providers closely involved in the day-to-day operation and care provision. There is clear leadership and staff and service users are able to contribute their ideas and views. Health and safety issues are promoted but can be improved, especially in the areas of fire drill practice and hot water safety. EVIDENCE: The registered providers are involved in the day-to-day running of the home. One of the registered providers is also the registered home manager. Both individuals work shifts with the service users and know them well. Both are nursing qualified and experienced in working with service users with mental illness. Staff do not have a written contract/statement of terms and conditions and these are required to ensure that service users benefit from staff having a professional relationship with home management. The registered providers Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 21 have devised these contracts but they are yet to be distributed and agreed by staff. (See requirement 4). There is regular consultation with service users through house meetings and quality assurance questionnaires. Minutes of these meetings provide evidence that service users are consulted about household issues and staffing arrangements. The registered provider has arranged for a care manager from another company to visit the home and conduct quality assurance inspections on the service provided at Ambleside Lodge. Records are well maintained and stored securely in the staff office. Fire detection and fire fighting equipment are in place. The last professional equipment check was conducted in May 2005. Visual inspections and fire alarm call points tests are conducted by staff during regular health and safety checks. Fire evacuation drills have not been held with the required frequency. (See requirement 5). COSHH (substances hazardous to health) materials are safely stored. Sharp knives are counted daily and stored securely. Small electrical appliances had been subject to an annual safety check in March 2005. The mains electrical system had been safety tested in January 2005. The gas appliances had been safety tested in January 2006. Hot water temperatures are not thermostatically controlled to within safe limits. This is an unmet requirement from the previous inspection reports. The home manager said that the thermostatic control valves had been purchased but had not yet been fitted. (See requirement 6). Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 N/A 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 X 2 X 3 X 3 2 X Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15(2) Requirement The registered person must ensure that a new individual care plan is developed when an existing care plan is reviewed /evaluated and goals have been achieved. The registered persons must supply the CSCI with details of the arrangements in place to minimise disruption to service users whilst building work is underway. The registered persons must confirm that all new staff have completed/are completing induction training to Skills for Care specifications. Previous timescale of 30/09/05 not met. The registered persons must provide all staff with contracts and a statement of terms and conditions. Previous timescale of 28/10/05 not met. The registered persons must ensure that fire evacuation drills are conducted regularly. The date, time, participants and results of these drills must be DS0000022780.V280560.R01.S.doc Timescale for action 31/03/06 2 YA24 23(1)(a) 24/02/06 3 YA35 18(1) 31/03/06 4 YA37 12(5)(a) 31/03/06 5 YA42 23(4)(e) 24/02/06 Ambleside Lodge Version 5.1 Page 24 6 YA42 12, 13 & 23 recorded. Previous timescale of 26/08/05 not met. The registered person must ensure that hot water temperatures are tested regularly and that temperatures are restricted to a temperature close to 43 degrees Celcius. This can be achieved by fitting thermostatic control valves to each hot water outlet. Previous timescales of 29/04/05 & 25/11/05 not met. 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA17 Good Practice Recommendations The registered person should develop a programme of skills teaching and reducing support around budgeting, shopping and food preparation for service users moving towards independent living. The registered person should introduce a record of outcomes of the justified medication stock checks taking place each week. The record should detail any discrepancies and any actions taken as a result. The registered persons should recruit a sufficient number of full time staff. 2 YA20 3 YA33 Ambleside Lodge DS0000022780.V280560.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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